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Open Access 01-12-2017 | Research

Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification

Authors: Toshiya Kamiyama, Tatsuya Orimo, Kenji Wakayama, Shingo Shimada, Akihisa Nagatsu, Hideki Yokoo, Hirofumi Kamachi, Kenichiro Yamashita, Tsuyoshi Shimamura, Akinobu Taketomi

Published in: World Journal of Surgical Oncology | Issue 1/2017

Abstract

Background

Because hepatectomy is not recommended in patients with stage B hepatocellular carcinoma (HCC) of the Barcelona Clinic Liver Cancer (BCLC) staging, we evaluated the survival outcomes of hepatectomy for stage B in the BCLC system.

Methods

Data were collected from 297 consecutive adult stage B patients who underwent curative hepatectomy for HCC between 1996 and 2014 in Hokkaido University Hospital. Overall survival (OS), disease-free survival (DFS), and risk factors were analyzed using the Kaplan–Meier method. Independent prognostic factors were evaluated using a Cox proportional hazards regression model. AP-factor (alpha-fetoprotein [AFP] × protein induced by vitamin K absence or antagonism factor II [PIVKA-II]) was categorized according to the serum concentrations of AFP and PIVKA-II: AP1 (AFP < 200 ng/ml and PIVKA-II < 100 mAU/ml), AP2 (AFP × PIVKA-II < 10⁵), and AP3 (AFP × PIVKA-II ≥ 10⁵).

Results

There were 130 deaths among our 297 stage B patients (43.8%). The causes of death in these cases were HCC recurrence (n = 106; 81.5%), liver failure (n = 7; 5.4%), and other causes (n = 17; 16.1%). The operative mortality rate was 0.34% (1/297). The 5-year OS and DFS rates for the stage B cases were 54.3 and 21.9%, respectively. By multivariate analysis, tumor number and AP-factor were risk factors for both survival and recurrence that were tumor related and could be evaluated preoperatively. The study patients with stage B HCC were classified into three groups by tumor number (B1, 1; B23, 2 or 3; B4over: ≥4) and into three groups stratified by AP-factor (AP1, AP2, and AP3). The 5-year OS rates of B1, B23, and B4over were 63.6, 52.3, and 29.0%. The 5-year OS rates of AP1, AP2, and AP3 were 67.6, 65.2, and 39.1%. Stratified by the 5-year OS rate, stage B HCC patients were classified into three subgroups (A-C).The 5-year OS rates of groups A (B1 or B23 and AP-1 or AP-2), B (B1 or B23 and AP-3, or B4over and AP-1 or AP-2), and C (B4over and AP-3) were 69.5, 43.7, and 21.3%.

Conclusion

Stage B HCC patients with a tumor number ≤ 3 and/or AP-factor < 1 × 10⁵ show acceptable 5-year OS rates and could be treated by hepatectomy.

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Title: Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification
Authors: Toshiya Kamiyama
Tatsuya Orimo
Kenji Wakayama
Shingo Shimada
Akihisa Nagatsu
Hideki Yokoo
Hirofumi Kamachi
Kenichiro Yamashita
Tsuyoshi Shimamura
Akinobu Taketomi
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: World Journal of Surgical Oncology / Issue 1/2017
Electronic ISSN: 1477-7819
DOI: https://doi.org/10.1186/s12957-017-1229-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Survival outcomes of hepatectomy for stage B Hepatocellular carcinoma in the BCLC classification

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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